Transformer-based charging circuits for implantable medical devices

ABSTRACT

An implantable medical device includes a low-power circuit, a high-power circuit, and a dual-cell power source. The power source is coupled to a transformer having first and second primary windings, each of which is selectively coupled to the power source and a plurality of secondary windings that are magnetically coupled to the first and second primary windings. The plurality of secondary windings are interlaced along a length of each of the secondary windings. Each of the plurality of secondary transformer windings is coupled to a capacitor, and the capacitors are all connected in a series configuration. The low power circuit is coupled to the power source and issues a control signal to control the delivery of charge from the power source to the plurality of capacitors through the first and second transformers.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application claims the benefit of U.S. Provisional Application No. 62/047,158, filed on Sep. 8, 2014. The disclosure of the above application is incorporated herein by reference in its entirety.

The present application is related to co-pending and commonly-assigned U.S. patent application Ser. No. 14/695,264 (Atty. Docket No.: C00006865.USU2) which is entitled Multi-Primary Transformer Charging Circuits for Implantable Medical Devices; U.S. patent application Ser. No. 14/695,309 (Atty. Docket No.: C00006923.USU2), which is entitled Implantable Medical Devices Having Multi-Cell Power Sources; U.S. patent application Ser. No. 14/695,447 (Atty. Docket No.: C00006924.USU2), which is entitled Multiple Transformer Charging Circuits for Implantable Medical Devices; U.S. patent application Ser. No. 14/695,948 (Atty. Docket No.: C00007044.USU2), which is entitled Implantable Medical Devices Having Multi-Cell Power Sources; U.S. patent application Ser. No. 14/695,887 (Atty. Docket No.: C00007047.USU2), which is entitled Transthoracic Protection Circuit for Implantable Medical Devices; and U.S. patent application Ser. No. 14/695,826 (Atty. Docket No.: C00008057.USU3), which is entitled Monitoring Multi-Cell Power Source of an Implantable Medical Device, all of which are filed concurrently herewith and all of which are incorporated herein by reference in their entireties.

FIELD

The present disclosure relates to body implantable medical devices and, more particularly to circuits and techniques implemented in an implantable medical device to provide an electrical therapeutic output.

BACKGROUND

The human anatomy includes many types of tissues that can either voluntarily or involuntarily, perform certain functions. After disease, injury, or natural defects, certain tissues may no longer operate within general anatomical norms. For example, organs such as the heart may begin to experience certain failures or deficiencies. Some of these failures or deficiencies can be diagnosed, corrected or treated with implantable medical devices.

Implantable medical electrical leads are used with a wide variety of these implantable medical devices. The medical leads may be configured to allow electrodes to be positioned at desired cardiac locations so that the device can monitor and/or deliver stimulation therapy to the desired locations. For example, electrodes on implantable leads may detect electrical signals within a patient, such as an electrocardiogram, in addition to delivering electrical stimulation.

Currently, ICD's use endocardial or epicardial leads which extend from the ICD housing through the venous system to the heart. Electrodes positioned in or adjacent to the heart by the leads are used for pacing and sensing functions. Cardioversion and defibrillation shocks are generally applied between a coil electrode carried by one of the leads and the ICD housing, which acts as an active can electrode.

A subcutaneous implantable cardioverter defibrillator (SubQ ICD) differs from the more commonly used ICD's in that the housing and leads are typically implanted subcutaneously such that the sensing and therapy are accomplished subcutaneously. The SubQ ICD does not require leads to be placed in the heart or in contact with the heart. Instead, the SubQ ICD makes use of one or more electrodes on the housing, together with a subcutaneous lead that carries a defibrillation coil electrode and a sensing electrode.

The implantable medical devices are typically battery powered and often utilize capacitors or other electrical charge storage components to hold an electrical output to be made available to a patient. Due to the nature of defibrillation therapy or other high voltage therapy, it is not practical for the implantable medical device to supply the energy upon instantaneous demand by drawing from the power source. Instead, additional circuitry is provided to transfer and store the energy from the power source to accumulate a desired voltage level.

However, the placement of the SubQ ICD lead(s) and electrode(s) outside the heart presents a challenge to generating sufficient energy levels that are required to deliver appropriate therapy. As described herein, the present disclosure addresses the need in art to provide circuitry and techniques for generating appropriate electrical stimulation therapy in a SubQ ICD system.

SUMMARY

In accordance with aspects of this disclosure, circuits and techniques implemented in an implantable medical device are provided for generating an electrical stimulation therapy from a multi-cell power source. Such electrical stimulation therapy exhibits an output having a higher voltage than the voltage available directly from the battery or a higher current than the current available directly from the battery.

In accordance with some embodiments, the implantable medical device includes a power source, a plurality of primary windings selectively coupled to the power source, a plurality of secondary windings magnetically coupled to the plurality of primary windings to define a transformer, with the plurality of secondary windings being interlaced along a length of each of the secondary windings; and a capacitor array coupled to the plurality of secondary transformer windings, with each capacitor in the capacitor array being coupled to an individual one of the plurality of secondary transformer windings.

In further aspects of the embodiments of the present disclosure, the plurality of secondary windings comprises six wires.

In further aspects of the embodiments of the present disclosure, the implantable medical device further comprises a core including magnetic material, with the plurality of primary windings and the plurality of secondary windings being wound around the core.

In further aspects of the embodiments of the present disclosure, the plurality of primary windings comprises at least a first winding and a second winding

In further aspects of the embodiments of the present disclosure, the plurality of secondary windings comprises wire having a first gauge and the plurality of primary windings comprises wire having a second gauge that is heavier than the first gauge.

BRIEF DESCRIPTION OF THE DRAWINGS

The following drawings are illustrative of particular embodiments of the present disclosure and therefore do not limit the scope of the disclosure. The drawings are not to scale (unless so stated) and are intended for use in conjunction with the explanations in the following detailed description. Embodiments will hereinafter be described in conjunction with the appended drawings wherein like numerals/letters denote like elements, and:

FIG. 1 is a front view of a patient implanted with an implantable cardiac system;

FIG. 2 is a side view the patient implanted with an implantable cardiac system;

FIG. 3 is a transverse view of the patient implanted with an implantable cardiac system;

FIG. 4 depicts a schematic diagram of an embodiment of operational circuitry included in an implantable cardiac defibrillator of the cardiac system of FIGS. 1-3;

FIG. 5 illustrates an exemplary schematic diagram showing a portion of the operational circuitry of FIG. 4 in accordance with an embodiment of the disclosure;

FIG. 6A illustrates a perspective view of a transformer in accordance with an embodiment of the disclosure;

FIG. 6B is a perspective view of the plurality of secondary windings of the transformer of FIG. 6A in accordance with an embodiment;

FIG. 6C depicts the plurality of secondary windings of the transformer of FIG. 6A in accordance with an embodiment; and

FIG. 7 illustrates an exemplary schematic diagram showing a portion of the operational circuitry of FIG. 4 in accordance with an embodiment of the disclosure.

DETAILED DESCRIPTION

FIG. 1 is a conceptual diagram of a patient 12 implanted with an example extravascular cardiac defibrillation system 10. In the example illustrated in FIG. 1, extravascular cardiac defibrillation system 10 is an implanted subcutaneous defibrillation system for purposes of illustration.

Extravascular cardiac defibrillation system 10 includes an implantable medical device such as implantable cardiac defibrillator (ICD) 14 connected to at least one implantable cardiac defibrillation lead 16. ICD 14 of FIG. 1 is implanted subcutaneously on the left side of patient 12. Defibrillation lead 16, which is connected to ICD 14, extends medially from ICD 14 toward sternum 28 and xiphoid process 24 of patient 12. At a location near xiphoid process 24 defibrillation lead 16 bends or turns and extends subcutaneously superior, substantially parallel to sternum 28. In the example illustrated in FIG. 1, defibrillation lead 16 is implanted such that lead 16 is offset laterally to the left side of the body of sternum 28 (i.e., towards the left side of patient 12).

ICD 14 may interact with an external device 4 such as a patient programmer or a clinician programmer via a 2-way telemetry link. Such a programmer communicates with ICD 14 via telemetry as is known in the art. The programmer 4 may thereby establish a telemetry session with ICD 14 to provide programs, instructions, parameters, data, and other information to ICD 14, and to likewise receive status, data, parameters, programs, and other information from the ICD 14. Status information received from the ICD 14 may include data about the remaining longevity of the power source (e.g., a battery) based on the amount of charge that has thus far been delivered by the battery and consumed by the ICD 14 as compared to when the battery was in the full-charged state (“battery capacity”). Status information may also include an “Elective Replacement Indicator” (ERI) to indicate when surgery must be scheduled to replace ICD 14. Status may also include an “End of Life” (EOL), which is activated to signify end-of-battery life.

Defibrillation lead 16 is placed along sternum 28 such that a therapy vector between defibrillation electrode 32 and a second electrode (such as a housing or can electrode 36 of ICD 14 or an electrode placed on a second lead) is substantially across the ventricle of heart 26. The therapy vector may, in one example, be viewed as a line that extends from a point on the defibrillation electrode 32 to a point on the housing or can electrode 36 of ICD 14. In another example, defibrillation lead 16 may be placed along sternum 28 such that a therapy vector between defibrillation electrode 32 and a housing or can electrode 36 of ICD 14 (or other electrode) is substantially across an atrium of heart 26. In this case, extravascular ICD system 10 may be used to provide atrial therapies, such as therapies to treat atrial fibrillation.

The embodiment illustrated in FIG. 1 is an example configuration of an extravascular ICD system 10 and should not be considered limiting of the techniques described herein. For example, although illustrated as being offset laterally from the midline of sternum 28 in the example of FIG. 1, defibrillation lead 16 may be implanted such that lead 16 is offset to the right of sternum 28 or over sternum 28. Additionally, defibrillation lead 16 may be implanted such that it is not substantially parallel to sternum 28, but instead offset from sternum 28 at an angle (e.g., angled lateral from sternum 28 at either the proximal or distal end). As another example, the distal end of defibrillation lead 16 may be positioned near the second or third rib of patient 12. However, the distal end of defibrillation lead 16 may be positioned further superior or inferior depending on the location of ICD 14, location of electrodes 32, 34, and 30, or other factors.

Although ICD 14 is illustrated as being implanted near a midaxillary line of patient 12, ICD 14 may also be implanted at other subcutaneous locations on patient 12, such as further posterior on the torso toward the posterior axillary line, further anterior on the torso toward the anterior axillary line, in a pectoral region, or at other locations of patient 12. In instances in which ICD 14 is implanted pectorally, lead 16 would follow a different path, e.g., across the upper chest area and inferior along sternum 28. When the ICD 14 is implanted in the pectoral region, the extravascular ICD system may include a second lead including a defibrillation electrode that extends along the left side of the patient such that the defibrillation electrode of the second lead is located along the left side of the patient to function as an anode or cathode of the therapy vector of such an ICD system.

ICD 14 includes a housing that forms a hermetic seal that protects components within ICD 14. The housing of ICD 14 may be formed of a conductive material, such as titanium or other biocompatible conductive material or a combination of conductive and non-conductive materials. In some instances, the housing of ICD 14 functions as an electrode (sometimes referred to as a housing electrode or can electrode) that is used in combination with one of electrodes 32, 34, or 30 to deliver a therapy to heart 26 or to sense electrical activity of heart 26. ICD 14 may also include a connector assembly (sometimes referred to as a connector block or header) that includes electrical feedthroughs through which electrical connections are made between conductors within defibrillation lead 16 and electronic components included within the housing. The housing may enclose one or more components, including processors, memories, transmitters, receivers, sensors, sensing circuitry, therapy circuitry and other appropriate components (often referred to herein as modules).

Defibrillation lead 16 includes a lead body having a proximal end that includes a connector configured to connect to ICD 14 and a distal end that includes one or more electrodes 32, 34, and 30. The lead body of defibrillation lead 16 may be formed from a non-conductive material, including silicone, polyurethane, fluoropolymers, mixtures thereof, and other appropriate materials, and shaped to form one or more lumens within which the one or more conductors extend. However, the techniques are not limited to such constructions. Although defibrillation lead 16 is illustrated as including three electrodes 32, 34 and 30, defibrillation lead 16 may include more or fewer electrodes.

Defibrillation lead 16 includes one or more elongated electrical conductors (not illustrated) that extend within the lead body from the connector on the proximal end of defibrillation lead 16 to electrodes 32, 34 and 30. In other words, each of the one or more elongated electrical conductors contained within the lead body of defibrillation lead 16 may engage with respective ones of electrodes 32, 34 and 30. When the connector at the proximal end of defibrillation lead 16 is connected to ICD 14, the respective conductors may electrically couple to circuitry, such as a therapy module or a sensing module, of ICD 14 via connections in connector assembly, including associated feedthroughs. The electrical conductors transmit therapy from a therapy module within ICD 14 to one or more of electrodes 32, 34 and 30 and transmit sensed electrical signals from one or more of electrodes 32, 34 and 30 to the sensing module within ICD 14.

ICD 14 may sense electrical activity of heart 26 via one or more sensing vectors that include combinations of electrodes 34 and 30 and a housing or can electrode 36 of ICD 14. For example, ICD 14 may obtain electrical signals sensed using a sensing vector between electrodes 34 and 30, obtain electrical signals sensed using a sensing vector between electrode 34 and the conductive housing or can electrode 36 of ICD 14, obtain electrical signals sensed using a sensing vector between electrode 30 and the conductive housing or can electrode 36 of ICD 14, or a combination thereof. In some instances, ICD 14 may even sense cardiac electrical signals using a sensing vector that includes defibrillation electrode 32, such as a sensing vector between defibrillation electrode 32 and one of electrodes 34 or 30, or a sensing vector between defibrillation electrode 32 and the housing or can electrode 36 of ICD 14.

ICD 14 may analyze the sensed electrical signals to detect tachycardia, such as ventricular tachycardia or ventricular fibrillation, and in response to detecting tachycardia may generate and deliver an electrical therapy to heart 26. For example, ICD 14 may deliver one or more defibrillation shocks via a therapy vector that includes defibrillation electrode 32 of defibrillation lead 16 and the housing/can electrode. Defibrillation electrode 32 may, for example, be an elongated coil electrode or other type of electrode. In some instances, ICD 14 may deliver one or more pacing therapies prior to or after delivery of the defibrillation shock, such as anti-tachycardia pacing (ATP) or post shock pacing. In these instances, ICD 14 may generate and deliver pacing pulses via therapy vectors that include one or both of electrodes 34 and 30 and/or the housing/can electrode. Electrodes 34 and 30 may comprise ring electrodes, hemispherical electrodes, coil electrodes, helix electrodes, segmented electrodes, directional electrodes, or other types of electrodes, or combination thereof. Electrodes 34 and 30 may be the same type of electrodes or different types of electrodes, although in the example of FIG. 1 both electrodes 34 and 30 are illustrated as ring electrodes.

Defibrillation lead 16 may also include an attachment feature 29 at or toward the distal end of lead 16. The attachment feature 29 may be a loop, link, or other attachment feature. For example, attachment feature 29 may be a loop formed by a suture. As another example, attachment feature 29 may be a loop, link, ring of metal, coated metal or a polymer. The attachment feature 29 may be formed into any of a number of shapes with uniform or varying thickness and varying dimensions. Attachment feature 29 may be integral to the lead or may be added by the user prior to implantation. Attachment feature 29 may be useful to aid in implantation of lead 16 and/or for securing lead 16 to a desired implant location. In some instances, defibrillation lead 16 may include a fixation mechanism in addition to or instead of the attachment feature. Although defibrillation lead 16 is illustrated with an attachment feature 29, in other examples lead 16 may not include an attachment feature 29. In this case, defibrillation lead 16 may be connected to or secured to an implant tool via an interference fit as will be described in more detail herein. An interference fit, sometimes also referred to as a friction fit, is a fastening between two parts which is achieved by friction after the parts are pushed together, rather than by any other means of fastening.

Lead 16 may also include a connector at the proximal end of lead 16, such as a DF4 connector, bifurcated connector (e.g., DF-1/IS-1 connector), or other type of connector. The connector at the proximal end of lead 16 may include a terminal pin that couples to a port within the connector assembly of ICD 14. In some instances, lead 16 may include an attachment feature at the proximal end of lead 16 that may be coupled to an implant tool to aid in implantation of lead 16. The attachment feature at the proximal end of the lead may separate from the connector and may be either integral to the lead or added by the user prior to implantation.

Defibrillation lead 16 may also include a suture sleeve or other fixation mechanism (not shown) located proximal to electrode 30 that is configured to fixate lead 16 near the xiphoid process or lower sternum location. The fixation mechanism (e.g., suture sleeve or other mechanism) may be integral to the lead or may be added by the user prior to implantation.

The example illustrated in FIG. 1 is exemplary in nature and should not be considered limiting of the techniques described in this disclosure. For instance, extravascular cardiac defibrillation system 10 may include more than one lead. In one example, extravascular cardiac defibrillation system 10 may include a pacing lead in addition to defibrillation lead 16.

In the example illustrated in FIG. 1, defibrillation lead 16 is implanted subcutaneously, e.g., between the skin and the ribs and/or sternum. In other instances, defibrillation lead 16 (and/or the optional pacing lead) may be implanted at other extravascular locations. In one example, defibrillation lead 16 may be implanted at least partially in a substernal location. In such a configuration, at least a portion of defibrillation lead 16 may be placed under or below the sternum in the mediastinum and, more particularly, in the anterior mediastinum. The anterior mediastinum is bounded laterally by pleurae, posteriorly by pericardium, and anteriorly by sternum. Defibrillation lead 16 may be at least partially implanted in other extra-pericardial locations, i.e., locations in the region around, but not in direct contact with, the outer surface of heart 26. These other extra-pericardial locations may include in the mediastinum but offset from sternum 28, in the superior mediastinum, in the middle mediastinum, in the posterior mediastinum, in the sub-xiphoid or inferior xiphoid area, near the apex of the heart, or other location not in direct contact with heart 26 and not subcutaneous. In still further instances, the implant tools described herein may be utilized to implant the lead at a pericardial or epicardial location outside the heart 26. Moreover, implant tools such as those described herein may be used to implant non-cardiac leads in other locations within patient 12.

In an example, lead 16 may be placed in the mediastinum and, more particularly, in the anterior mediastinum. The anterior mediastinum is bounded laterally by pleurae 40, posteriorly by pericardium 38, and anteriorly by sternum 22. Lead 16 may be implanted within the mediastinum such that one or more electrodes 32 and 34 are located over a cardiac silhouette of the ventricle as observed via fluoroscopy. In the example illustrated in FIGS. 1-3, lead 16 is located substantially centered under sternum 22. In other instances, however, lead 16 may be implanted such that it is offset laterally from the center of sternum 22. Although described herein as being implanted in the substernal space, the mediastinum, or the anterior mediastinum, lead 16 may be implanted in other extra-pericardial locations.

Electrodes 30, 32, and 34 may comprise ring electrodes, hemispherical electrodes, coil electrodes, helical electrodes, ribbon electrodes, or other types of electrodes, or combinations thereof. Electrodes 30, 32 and 34 may be the same type of electrodes or different types of electrodes. In the example illustrated in FIGS. 1-3 electrode 34 is a coil electrode and electrodes 30 and 34 are ring, or hemispherical electrodes.

FIG. 4 is a schematic diagram of operational circuitry 48 included in ICD 14 according to an embodiment of the present disclosure. It is understood that the system of FIG. 4 includes both low power circuitry and high power circuitry. The present disclosure may be employed in a device that provides either or both of a high power electrical stimulation therapy, such as a high power defibrillation therapy, or a low power electrical stimulation therapy, such a pacing pulse, or both. Accordingly, the components in the operational circuitry 48 may support generation and delivery of either one or both such therapies. For ease of description, this disclosure will describe an operational circuitry 48 that supports only a high power electrical stimulation therapy, such as cardioversion and/or defibrillation stimulation therapy. However, it should be noted that the operational circuitry 48 may also provide defibrillation threshold (DFT) induction therapy or post-shock pacing such as anti-tachycardia pacing (ATP) therapy.

The operational circuitry 48 is provided with at least one or more power sources 46 which may include a rechargeable and/or non-rechargeable battery having one or more cells. As used in this disclosure, the term “cell” refers to a battery cell which, as is understood in the art, includes an anode terminal and a cathode terminal. An example of a battery cell is set forth in commonly assigned U.S. Patent Application No. US 2011/0179637 “Implantable Medical Devices with Low Volume Batteries, and Systems”, to Norton which is incorporated herein by reference. As described in greater detail below, the power source 46 can assume a wide variety of forms. Similarly, the operational circuitry 48, which includes the low power circuit 60 and the output circuit 56, can include analog and/or digital circuits, can assume a variety of configurations, and is electrically connected to the power source 46.

The output circuit 56 and the low power circuit 60 are typically provided as part of an electronics module associated with the ICD 14. In general terms, the output circuit 56 is configured to deliver an electrical pulse therapy, such as a defibrillation or a cardioversion/defibrillation pulse. In sum, the output circuit 56 is responsible for applying stimulating pulse energy between the various electrodes 28-34 (FIG. 1) of the ICD 14. As is known in the art, the output circuit 56 may be associated with a capacitor bank (not shown) for generating an appropriate output energy, for example in the range of 0.1-40 Joules.

The low power circuit 60 is similarly well known in the art. In general terms, the low power circuit 60 monitors heart activity and signals activation of the output circuit 56 for delivery of an appropriate stimulation therapy. Further, as known in the art, the low power circuit 60 may generate a predetermined series of pulses from the output circuit 56 as part of an overall therapy.

In an embodiment, ICD 14 functions are controlled by means of stored software, firmware and hardware that cooperatively monitor the EGM, determine when a cardioversion or defibrillation shock necessary, and deliver prescribed defibrillation therapies. The schematic diagram of FIG. 4 incorporates circuitry set forth in commonly assigned U.S. Pat. No. 5,163,427 “Apparatus for Delivering Single and Multiple Cardioversion and Defibrillation Pulses” to Keimel and U.S. Pat. No. 5,188,105 “Apparatus and Method for Treating a Tachyarrhythmia” to Keimel, for example, both incorporated herein by reference in their entireties, for selectively delivering single phase, simultaneous biphasic and sequential biphasic cardioversion-defibrillation stimulation therapy. In an exemplary implementation, IMD 14 may deliver stimulation therapy employing housing electrode 36 coupled to the terminal HV-A and at least one electrode such as electrode 32 coupled to the node HV-B output (at terminals 36 a and 32 a, respectively) of the output circuit 56. In alternative embodiments, the IMD 14 may employ additional electrodes such as electrodes 30, 34 coupled to nodes such as S1, S2 (at terminals 30 a and 34 a, respectively) for sensing or stimulation therapy.

The cardioversion-defibrillation stimulation therapy energy and capacitor charge voltages can be intermediate to those supplied by ICDs having at least one cardioversion-defibrillation electrode in contact with the heart and most AEDs having cardioversion-defibrillation electrodes in contact with the skin. The typical maximum voltage necessary for ICD 14 using most biphasic waveforms is approximately 750 Volts with an associated maximum energy of approximately 40 Joules. The typical maximum voltage necessary for AEDs is approximately 2000-5000 Volts with an associated maximum energy of approximately 200-360 Joules depending upon the waveform used. The SubQ ICD 14 of the present disclosure uses maximum voltages in the range of about 700 to about 3150 Volts and is associated with energies of about 25 Joules to about 210 Joules. The total high voltage capacitance could range from about 50 to about 300 microfarads.

Such cardioversion-defibrillation stimulation therapies are only delivered when a malignant tachyarrhythmia, e.g., ventricular fibrillation is detected through processing of the far field cardiac ECG employing one of the available detection algorithms known in the ICD 14 art.

In FIG. 4, pacer timing/sense amplifier circuit 52 processes the far field ECG SENSE signal that is developed across a particular ECG sense vector defined by a selected pair of the electrodes 36, 32, and optionally, electrodes 30, 34 if present as noted above. The selection of the sensing electrode pair is made through a control circuit 54 in a manner to provide the most reliable sensing of the EGM signal of interest, which would be the R wave for patients who are believed to be at risk of ventricular fibrillation leading to sudden death. The far field ECG signals are passed through the control circuit 54 to the input of a sense amplifier in the pacer timing/sense amplifier circuit 52.

Control circuit 54 may comprise one or more microprocessors, Application-Specific Integrated Circuits (ASICs), Digital Signal Processors (DSPs), Field-Programmable Gate Arrays (FPGAs), discrete electronic components, state machines, sensors, and/or other circuitry. Control circuit 54 may operate under the control of programmed instructions such as software and/or firmware instructions stored within a storage device (70). The storage device may include volatile, non-volatile, magnetic, optical, and/or electrical media for storing digital data and programmed instructions, including Random Access Memory (RAM), Read-Only Memory (ROM), Non-Volatile RAM (NVRAM), Electrically Erasable Programmable ROM (EEPROM), flash memory, removable storage devices, and the like. These one or more storage devices 70 may store programs executed by control circuit 54.

Storage devices 70 may likewise store data, which may include, but is not limited to, programmed parameters, patient information, data sensed from the patient, and status information indicating the status of the ICD 14. For instance, the data may include statistical information and other characteristic data about the battery (or individual cell) that is used to predict charge remaining within the power source 46 of ICD 14 as will be discussed in more detail below. The data may further contain ERI and/or EOL indicators to indicate when replacement operations will be needed. This information may be provided to a clinician or patient via the external device 4.

Detection of a malignant tachyarrhythmia is determined via the control circuit 54 as a function of one or more sensed signals (e.g., R-wave signals and/or P-wave signals) that are output from the pacer timing/sense amplifier circuit 52 to the control circuit 54. An example detection algorithm is described in U.S. Pat. No. 7,103,404, titled “Detection of Tachyarrhythmia Termination”, issued to Stadler, which is incorporated herein by reference in its entirety. Certain steps in the performance of the detection algorithm criteria are cooperatively performed in a microcomputer 50, including stored detection criteria that may be programmed into via a telemetry interface (not shown) conventional in the art.

The microcomputer 50 is generally representative of a processor and associated memory in storage device 70. The memory may reside internally within the microcomputer 50, or separately in storage device 53. The memory, for example, may include computer readable instructions that, when executed by processor, cause the operational circuitry and or any other component of the medical device to perform various functions attributed to them. For example, the memory may include any volatile, non-volatile, magnetic, optical, or electrical media, such as a random access memory (RAM), read-only memory (ROM), non-volatile RAM (NVRAM), electrically-erasable programmable ROM (EEPROM), flash memory, or any other digital media. Such memory will typically be non-transitory. The processor, may include any one or more of a microprocessor, a digital signal processor (DSP), a controller, an application specific integrated circuit (ASIC), a field programmable gate array (FPGA), or equivalent discrete or integrated logic circuitry. In one or more exemplary embodiments, the processor may include multiple components, such as any combination of one or more microprocessors, one or more controllers, one or more DSPs, one or more ASICs, or one or more FPGAs, as well as other discrete or integrated logic circuitry. The functions attributed to the microcomputer 50 may be embodied as software, firmware, hardware, or any combination thereof.

Data and commands are exchanged between microcomputer 50 and control circuit 54, pacer timing/amplifier circuit 52, and output circuit 56 via a bi-directional data/control bus 61. The pacer timing/amplifier circuit 52 and the control circuit 54 are clocked at a slow clock rate. The microcomputer 50 is normally asleep, but is awakened and operated by a fast clock by interrupts developed by sensed cardiac events or on receipt of a downlink telemetry programming instruction or upon delivery of cardiac pacing pulses to perform any necessary mathematical calculations, to perform tachycardia and fibrillation detection procedures, and to update the time intervals monitored and controlled by the timers in pace/sense circuitry 52.

The detection algorithms are highly sensitive and specific for the presence or absence of life threatening ventricular arrhythmias, e.g., ventricular tachycardia (V-TACH) and ventricular fibrillation (V-FIB). As discussed above, the detection algorithms contemplated in accordance with this disclosure may utilize sensed cardiac signals to detect the arrhythmias. In addition, detection algorithms for atrial fibrillation may also be included.

Although the ICD 14 of the present disclosure may rarely be used for an actual sudden death event, the simplicity of design and implementation allows it to be employed in large populations of patients at modest risk with modest cost by medical personnel other than electrophysiologists. Consequently, the ICD 14 of the present disclosure includes the automatic detection and therapy of the most malignant rhythm disorders.

When a malignant tachycardia is detected, high voltage capacitors (not shown) within the output circuit are charged to a pre-programmed voltage level by a charging circuit 58. It is generally considered inefficient to maintain a constant charge at all times on the high voltage capacitors. Instead, charging is initiated when control circuit 54 issues a high voltage charge command delivered to charging circuit 58 and charging is controlled by means of bi-directional signal line(s) from the HV output circuit 56. Without intending to be limiting, the high voltage output capacitors may comprise film, aluminum electrolytic or wet tantalum construction. Some examples of the high voltage output capacitors are described in commonly assigned U.S. Pat. No. 8,086,312, titled “Capacitors for Medical Devices”, issued to Nielsen, which is incorporated herein by reference in its entirety.

The high voltage output capacitors may be charged to very high voltages, e.g., 700-3150V, to be discharged through the body and heart between the selected electrode pairs among first, second, and, optionally, third and/or fourth subcutaneous cardioversion-defibrillation electrodes 36, 32, 30, 32. The details of an exemplary charging circuit 58 and output circuit 56 will be discussed below. The high voltage capacitors are charged by charging circuit 58 and a high frequency, high-voltage transformer. The state of capacitor charge is monitored by circuitry within the output circuit 56 that provides a feedback signal indicative of the voltage to the control circuit 54. Control circuit 54 terminates the high voltage charge command when the received signal matches the programmed capacitor output voltage, i.e., the cardioversion-defibrillation peak shock voltage.

Control circuit 54 then develops a control signal that is applied to the output circuit 56 for triggering the delivery of cardioverting or defibrillating shocks. In this way, control circuitry 54 serves to control operation of the high voltage output stage 56, which delivers high energy cardioversion-defibrillation stimulation therapies between a selected pair or pairs of the first, second, and, optionally, the third and/or fourth cardioversion-defibrillation electrodes 36, 32, coupled to the HV-A, HV-B and optionally to other electrodes such as electrodes 34, 30 coupled to the S1, S2 terminals as shown in FIG. 4.

Thus, ICD 14 monitors the patient's cardiac status and initiates the delivery of a cardioversion-defibrillation stimulation therapy through a selected pair or pairs of the first, second, third and/or fourth electrodes 36, 32, 34, and 30 in response to detection of a tachyarrhythmia requiring cardioversion-defibrillation.

Typically, the charging cycle of the capacitors has a short duration, e.g., it can take anywhere from two seconds to about thirty seconds, and occurs very infrequently. The ICD 14 can be programmed to attempt to deliver cardioversion shocks to the heart in the manners described above in timed synchrony with a detected R-wave or can be programmed or fabricated to deliver defibrillation shocks to the heart in the manners described above without attempting to synchronize the delivery to a detected R-wave. Episode data related to the detection of the tachyarrhythmia and delivery of the cardioversion-defibrillation stimulation therapy can be stored in RAM for uplink telemetry transmission to an external programmer as is well known in the art to facilitate in diagnosis of the patient's cardiac state.

Housing 14 may include a telemetry circuit (not shown in FIG. 4), so that it is capable of being programmed by means of external device 4 (FIG. 1) via a 2-way telemetry link. Uplink telemetry allows device status and diagnostic/event data to be sent to external programmer for review by the patient's physician. Downlink telemetry allows the external programmer via physician control to allow the programming of device function and the optimization of the detection and therapy for a specific patient. Programmers and telemetry systems suitable for use in the practice of the present disclosure have been well known for many years. Known programmers typically communicate with an implanted device via a bi-directional telemetry link such as Bluetooth®, radio-frequency, near field, or low frequency telemetry link, so that the programmer can transmit control commands and operational parameter values to be received by the implanted device, and so that the implanted device can communicate diagnostic and operational data to the programmer.

Those skilled in the art will appreciate that the various components of the low power circuit 60 i.e., pacer/sense circuit 52, control circuit 54, and microcomputer 50 are illustrated as separate components for ease of discussion. In alternative implementations, the functions attributed to these components 50, 52 and 54 may suitably be performed by a sole component.

As mentioned above, the control circuit 54 and output circuit 56 performs several functions. One of those is to monitor the state of capacitor charge of the high voltage output capacitors. Another function is to allow the controlled transfer of energy from the high voltage output capacitors to the patient.

FIG. 5 illustrates an exemplary schematic showing a portion of the operational circuitry 48 of FIG. 4, in accordance with an embodiment of the disclosure, in greater detail. The output circuit 56 allows the controlled transfer of energy from the energy storage capacitors to the patient 12.

The output circuit 56 includes four legs 80, 82, 84, and 86 that are interconnected. The interconnection of the four legs with legs 80 and 82 being configured in a parallel orientation alongside legs 84 and 86 and a bridge being provided to intersect each of the pair of parallel connected legs. As is shown in FIG. 5, the interconnected legs are arrayed to define a configuration includes a high side and a low side that may resemble a “H”. In other words, the four interconnected legs are arrayed having legs 80 and 84 defining the high side and legs 82 and 86 defining the low side.

The intersecting bridge includes HV-A and HV-B terminals that couple the output circuit 56 to the cardioversion electrodes 36 and 32. As previously described, patient 12 is connectable (e.g., using leads/electrodes 36, 32 and any other suitable connections) between terminal HV-A located between the switch 80 and switch 82 and terminal HV-B located between switch 84 and switch 86.

Legs 80 and 84 are coupled to a positive terminal of the energy storage capacitors. An optional discharge switch 88, such as an insulated gate bipolar transistor (IGBT), may be used in the coupling from the legs 80 and 84 to the positive terminal of the energy storage capacitors. Discharge switch 88 may be controlled by control circuit 54 (FIG. 4) that is included within the low power circuit 60 to close and remain in the conducting state during discharge of the capacitors. Leg 82 and 86 are coupled to a negative terminal of the energy storage capacitors. The selection of one or more of the switches 80, 82, 84, 86 under control of control circuit 54 may be used to provide one or more functions. For example, selection of certain switches in one or more configurations may be used to provide one or more types of stimulation pulses, or may be used to provide active or passive recharge, etc.

For example, in accordance with an embodiment, the ICD 14 provides a biphasic defibrillation pulse to the patient in the following manner. With reference to FIG. 5, once the energy storage capacitors are charged to a selected energy level, the switches 80, 86, and 88 are closed so as to provide a path from the capacitors to electrode 36, 32 for the application of a first phase of a defibrillation pulse to the patient 12. The stored energy travels from the positive terminal of the capacitors, through switch 88 through switch 80, across the patient 12, back through switch 86 to the negative terminal of the capacitors. The first phase of the biphasic pulse therefore applies a positive pulse from the electrode 36 to the electrode 32.

After the end of the first phase of the biphasic defibrillation pulse, the switches 88, 84 and 82 are switched on to start the second phase of the biphasic pulse. Switches 84 and 82 provide a path to apply a negative defibrillation pulse to the patient 12. With reference to FIG. 5, the energy travels from the positive terminal of the capacitors, through switch 88 to switch 84, across the electrodes 32, 36 coupled to the patient 12, and out through switch 82 to the negative terminal of the capacitors. The polarity of the second phase of the defibrillation pulse is therefore opposite in polarity to the first phase of the pulse.

FIG. 6A illustrates a perspective view of a transformer 64 in accordance with an embodiment of the disclosure. In the embodiment, the transformer 64 is a dual primary transformer. However, the principles of this disclosure may be extended to any transformer having a plurality of primary windings that includes more than two primary windings. The transformer 64 includes a first primary winding 206 a, a second primary winding 206 b, a core 214, and a plurality of secondary windings 216 a-f.

In some embodiments, the core 214 may comprise a magnetic material, while each of the primary windings 206 a, 206 b and secondary windings 216 a-f may comprise a conductive wire encapsulated by an insulative material. The conductive wire forming the primary windings may have a heavier gauge in comparison to the gauge of the conductive wire forming the secondary windings as measured in units of a standardized wire gauge system such as the American wire gauge (AWG). For example, the wire forming the primary windings may be 31 AWG while the wire forming the secondary windings may be 41 AWG. In an embodiment, each of the wires forming each of the secondary windings 216 a-f (or primary windings 206 a, 206 b) may have an identical resistance and/or inductance value—in other words, each of the wires will have a precisely matched resistance and/or inductance value. This may be achieved, for example, by providing a wire having a predetermined gauge and a common material.

In some embodiments, two or more wires may be coupled together to form any given primary winding 206. Utilizing two or more wires for any given primary winding 206 a or 206 b reduces the skin effect and lowers the alternating current (AC) resistance, while also lowering the overall primary direct current (DC) resistance which would otherwise contribute to power losses on the primary side of the transformer 64. In one example, multiple wires are coupled in parallel to achieve a primary resistance of about <10 milliohms (for each winding). In alternative embodiments, more than one wire could similarly be used for one or more of the secondary windings 216 a-f, provided that the resulting electrical properties of each of the secondary windings is matched to the electrical properties of the other secondary windings.

The assembly of transformer 64 is formed having each of the plurality of secondary windings 216 a-f being wound around the core 214. In addition, the first and second primary windings 206 a, 206 b are also wound around the core 214. In one embodiment, the plurality of secondary windings 216 a-f are first wound around the core 214, then the first and second primary windings 206 a, 206 b are wound around the core 214 over the plurality of secondary windings 216 a-f.

The winding configuration of the present disclosure enables transformer 64 to maintain an adjacency of each of the plurality of secondary windings 216 a-f on a turn-by-turn basis around the core 214. The adjacency may be selected based on the desired matching tolerance, which may be expressed as a percentage of the voltage generated by each of the plurality of secondary windings 216 a-f.

FIG. 6B is a perspective view of the plurality of secondary windings 216 a-f in accordance with one embodiment. As shown, the plurality of secondary windings 216 a-f are interlaced along a length (e.g., L-L for secondary winding 216 f) of each of the windings 216 a-f. That is, each one of the plurality of secondary windings 216 a-f is interlaced with the other five of the plurality of secondary windings 216 a-f. The voltage matching tolerance is a function of the adjacency, on a turn-by-turn basis, of each of the windings of the plurality of secondary windings 216 a-f around the core 214. Based on the interlaced configuration, each of the plurality of secondary windings 216 a-f is able to maintain the requisite adjacency when wound around the core 214. The adjacency of the plurality of secondary windings 216 a-f provides for a tight electromagnetic coupling of the each of the windings 216 a-f to the core 214. Moreover, interlacing the wires of the plurality of secondary windings 216 a-f yields a matching resistance and inductance for all secondary windings.

FIG. 6C depicts the plurality of secondary windings 216 a-f in accordance with one embodiment. Each of the plurality of secondary windings 216 a-f includes conductive wires 220 a-f, each of which is encased by an insulator 222 a-f. The insulation 222 a-f around each of the conductive wires 220 a-f provides a DC isolation amongst the windings. The plurality of secondary windings 216 a-f may optionally or additionally be encased by an insulator 224.

FIG. 7 is a schematic illustrating a portion of the operational circuit 48 of IMD 14. As previously mentioned, the operational circuit 48 includes at least one power source 46. The power source 46 may comprise a battery having at least two cells 102 a, 102 b (collectively “102”). In exemplary embodiments, the power source 46 may be programmable or static and may be a switched or linear regulated source, etc. In an embodiment, the cells 102 supply power to the operational circuit 48 as well as the charge for stimulation therapy energy. The battery may include cells 102 formed from LiCFx, LiMnO2, LiI2, LiSVO or LiMnO2, for example, as is known in the art.

Each of the cells 102 is coupled to transformer 64 that is included within the output circuit 56 (shown in dashed lines in FIG. 7). As discussed in conjunction with FIGS. 6A-C, embodiments of the present disclosure contemplate the transformer 64 being configured as a dual primary transformer having a first primary winding 206 a and a second primary winding 206 b. In the embodiment, the cell 102 a is coupled to the first primary winding 206 a and the cell 102 b is coupled to the second primary winding 206 b.

The inventors of the present disclosure have discovered that the winding configuration of the plurality of secondary windings 216 a-f around the core 214 impacts the amount of charge that is transferred from the transformer 64. In various applications, it may be desirable to have a transformer that will deliver a uniform magnitude of energy from each of the secondary windings 216 a-f. For example, the IMD 14 may have a capacitor coupled to each of the secondary windings 216 a-f and it may be desired that each capacitor be charged up to a given voltage in order to store a cumulative energy that is delivered in the form of a stimulation therapy pulse, such as a defibrillation pulse or a pacing pulse to patient 12. Such applications may require that the magnitude of the voltage that is stored in each capacitor be uniform—especially if the voltage approximates the maximum threshold voltage rating of each capacitor. Otherwise, a mismatch in the energy delivered through each of the plurality of secondary windings 216 a-f may cause the voltage delivered to one or more of the capacitors to exceed the capacitor(s) maximum voltage rating, or to result in non-uniform levels of voltage stored in the capacitors. Moreover, the capacitors may also have non-uniform leakage currents which may also affect the voltage storage. In such a situation, the transformer 64 would need to rebalance the voltage stored on each capacitor.

The transformer 64 of the present invention overcomes the challenges associated with such winding configurations by transferring charge having an equal magnitude to each of the capacitors. In particular, the assembly of transformer 64 is formed having each of the plurality of secondary windings 216 a-f being wound around the core 214, and the first and second primary windings 206 a, 206 b also being wound around the core 214. As such, all the secondary windings 206 a-f share the magnetic flux and output an identical voltage.

A first switching element 108 a is coupled between the first primary winding 206 a of the transformer and the cell 102 a. A second switching element 108 b is coupled between the second primary winding 206 b of the transformer 64 and the cell 102 a. Each of the switches 108 a, 108 b is coupled to a charge monitoring circuit, such as power source monitoring circuit 62 (FIG. 4), which issues control signals (CS1, CS2) to selectively actuate each of the switches 108 a, 108 b. The control signals may be issued to selectively actuate the switches 108 a, 108 b separately, simultaneously, or in any other desired manner. The control circuit issues the control signals CS1, CS2 that control an on-time for delivery of charge from the first and second cells 102 a, 102 b based on the value of a measured cumulative voltage stored in capacitors 122. In particular, the control signals CS control the duration of actuation of each of the switches 108 a, 108 b.

The power source 46 may be formed such that each cell includes a cathode (positive) terminal and an anode (negative) terminal. As is illustrated in the depicted embodiment, the cathode terminals of cells 102 a, 102 b are coupled to the primary winding 106 a and the primary winding 106 b, respectively, and the anode terminals are both connected to a common node, such as the circuit ground node. The switches 108 a, 108 b are also coupled to the common node. As such, a first circuit path is defined between the first cell 102 a and first primary winding 106 a and a second circuit path is defined between the second cell 102 b and the primary winding 106 b. In an alternative embodiment, the anode terminals of the cells 102 a, 102 b are coupled to the primary winding 106 a and the primary winding 106 b, respectively, and each of the cathode terminals is connected to a common node, such as the circuit ground node.

In one embodiment, the switches 108 are simultaneously actuated to a conducting state to enable current to flow from both cells 102 to the transformer 64. The actuation of the first switch 108 a into a closed position triggers charge transfer from the first cell 102 a to the first primary winding 206 a and actuation of the second switch 108 b into a closed position triggers charge transfer from the second cell 102 to the second primary winding 206 b. In other words, the closing of switch 108 a creates a current path for flow of current from the first cell 102 a to the first primary winding 206 a while the closing of switch 108 b creates a current path for flow of current from the second cell 102 b to the second primary winding 206 b.

Each of the secondary windings 116 a-f is coupled to a capacitor for storage of the charge generated by the transformer 64. Specifically, secondary winding 116 a is coupled to capacitor 122 a, secondary winding 116 b is coupled to capacitor 122 b, secondary winding 116 c is coupled to capacitor 122 c, secondary winding 116 d is coupled to capacitor 122 d, secondary winding 116 e is coupled to capacitor 122 e, and secondary winding 116 f is coupled to capacitor 122 f. The capacitors 122 a-f may all be coupled in series, or alternatively, in a combination series configuration that includes a subset of the six capacitors, such for example as three capacitors 122 a-c.

A diode is coupled between each of the secondary windings and the respectively coupled capacitor to bias the flow of current from the transformer to each of the capacitors. Specifically, a diode 120 a is coupled between secondary winding 116 a and capacitor 122 a, a diode 120 b is coupled between secondary winding 116 b and capacitor 122 b, a diode 120 c is coupled between secondary winding 116 c and capacitor 122 c, a diode 120 d is coupled between secondary winding 116 d and capacitor 122 d, a diode 120 e is coupled between secondary winding 116 e and capacitor 122 e, and a diode 120 f is coupled between secondary winding 116 f and capacitor 122 f.

As shown in FIG. 7, the cells 102 are arranged in a parallel configuration and each cell 102 a, 102 b simultaneously delivers charge to its respective primary winding 206 a, 206 b. Thus, the primary windings 206 a, 206 b are coupled in a parallel configuration. Although not shown in the figure, an isolation circuit may be provided to enable coupling of the cells 102 other circuitry of IMD 14. Such an isolation circuit enables the cells 102 to deliver current during high power current operations while allowing both cells to contribute to the current supply to other circuitry such as 50, 52, and 54 of operational circuit 48 (shown in FIG. 4) during low power current operations. The high power current operations include the delivery of energy to the transformer 64 to, for example, provide defibrillation therapy or other electrical stimulation therapy. The low power current operations include supply of power to digital and analog portions of the low power circuitry 60, for example. For simplicity of description, the interconnections between the cells 102 and all the components of the operational circuit 48 is not shown. In the event of a failure of one of the cells 102, the isolation circuit 110 isolates the failed cell from the other cell.

As previously discussed, the low power circuitry 60 may also include charge monitoring circuitry (e.g., control circuit 54) that is coupled to the output circuit 56 to monitor the voltage stored in the capacitors 122. The voltage stored in the capacitors 122 corresponds to the voltage that is to be delivered in the form of an electrical stimulation therapy pulse to patient 12. As is known in the art, this voltage may be in the range of 200 V to 1800 V.

Providing software, firmware and hardware to accomplish the present invention, given the disclosure herein, is within the abilities of one of skill in the art. For the sake of brevity, conventional techniques related to ventricular/atrial pressure sensing, IMD signal processing, telemetry, and other functional aspects of the systems (and the individual operating components of the systems) may not be described in detail herein. The connecting lines shown in the various figures contained herein are intended to represent example functional relationships and/or physical couplings between the various elements. It should be noted that many alternative or additional functional relationships or physical connections may be present in an embodiment of the subject matter.

The description refers to elements or nodes or features being “connected” or “coupled” together. As used herein, unless expressly stated otherwise, “connected” means that one element/node/feature is directly joined to (or directly communicates with) another element/node/feature, and not necessarily mechanically. Likewise, unless expressly stated otherwise, “coupled” means that one element/node/feature is directly or indirectly joined to (or directly or indirectly communicates with) another element/node/feature, and not necessarily mechanically. Thus, although the schematics shown in the figures depict exemplary arrangements of elements, additional intervening elements, devices, features, or components may be present in an embodiment of the depicted subject matter.

While the disclosure is susceptible to various modifications and alternative forms, specific embodiments thereof have been shown by way of example in the drawings and are herein described in detail. It should be understood, however, that the description herein of specific embodiments is not intended to limit the disclosure to the particular forms disclosed, but on the contrary, the intention is to cover all modifications, equivalents, and alternatives falling within the spirit and scope of the disclosure as defined by the appended claims. 

What is claimed is:
 1. An implantable medical device, comprising: a power source; a plurality of primary windings selectively coupled to the power source; a plurality of secondary windings magnetically coupled to the plurality of primary windings to define a transformer, wherein each one of the plurality of secondary windings is interlaced to the others of the plurality of secondary windings along a length defined by the plurality of secondary windings; and a capacitor array coupled to the plurality of secondary transformer windings, wherein each capacitor in the capacitor array is coupled to an individual one of the plurality of secondary transformer windings.
 2. The implantable medical device of claim 1, wherein the plurality of secondary windings comprises six wires.
 3. The implantable medical device of claim 2, wherein the capacitor array comprises six capacitors, and one of each of the capacitors is coupled to only one of the six wires of the plurality of secondary windings.
 4. The implantable medical device of claim 3, wherein a first pairing of capacitors is defined by coupling a first set of three of the six capacitors in series and a second pairing of capacitors is defined by coupling a second set of three of the six capacitors that are different from the capacitors in the first set in series.
 5. The implantable medical device of claim 1, further comprising a core including magnetic material, wherein the plurality of primary windings and the plurality of secondary windings are wound around the core.
 6. The implantable medical device of claim 1, wherein at least one of the plurality of primary windings comprises at least two wires.
 7. The implantable medical device of claim 1, further comprising a control circuit configured to define a charge time during which the plurality of primary windings are coupled to the power source and a discharge time during which the plurality of primary windings are uncoupled from the power source.
 8. The implantable medical device of claim 7, further comprising a switching element coupled between the power source and the plurality of primary windings, the switching element configured to receive a control signal from the control circuit to selectively couple the power source to the first primary winding during the charge time and to selectively decouple the power source from the first primary winding during the discharge time.
 9. The implantable medical device of claim 1, wherein the plurality of primary windings comprises at least a first primary winding and a second primary winding.
 10. The implantable medical device of claim 9, wherein the at least first and second primary windings are coupled to the power source in a parallel configuration.
 11. The implantable medical device of claim 9, further comprising a control circuit configured to define a first charge time during which the first primary winding is coupled to the power source and a first discharge time during which the first primary winding is uncoupled from the power source, and a second charge time during which the second primary winding is coupled to the power source and a second discharge time during which the second primary winding is uncoupled from the power source.
 12. The implantable medical device of claim 11, further comprising a switching element coupled between the power source and the plurality of primary windings, the switching element configured to receive a control signal from the control circuit to selectively couple the power source to the first primary winding during the charge time and to selectively decouple the power source from the first primary winding during the discharge time.
 13. The implantable medical device of claim 11, wherein the at least first and second primary windings are coupled to the power source in a parallel configuration.
 14. The implantable medical device of claim 11, wherein the at least first and second primary windings are interlaced along a length of each of the at least two primary windings.
 15. The implantable medical device of claim 9, wherein the at least first and second primary windings are interlaced along a length of each of the at least two primary windings.
 16. The implantable medical device of claim 1, wherein the plurality of secondary windings comprises wire having a first gauge and the plurality of primary windings comprises wire having a second gauge that is heavier than the first gauge.
 17. The implantable medical device of claim 16, wherein the plurality of primary windings comprises at least two wires coupled together.
 18. The implantable medical device of claim 1, further comprising a diode coupled in series between each of the plurality of secondary windings and the respective capacitor coupled to each one of the plurality of secondary windings.
 19. The implantable medical device of claim 1, wherein the wires of the plurality of secondary windings have an identical resistance value.
 20. The implantable medical device of claim 1, wherein each of the plurality of secondary windings is insulated.
 21. The implantable medical device of claim 1, wherein the wires of the plurality of secondary windings have an identical inductance value. 